complementary feeding - Ministry of Women and Child Development

Report
Warm Greetings !!
Andhra Pradesh – Making a difference !
in
ICDS and IYCF
Department for Women, Children, Disabled & Senior Citizens
Government of Andhra Pradesh
Importance of Infant and Young Child Feeding (IYCF) practices
Interventions for improving IYCF practices in Andhra Pradesh
Share of under-five deaths (%), 2011, by country
5 countries contribute towards 50% of child deaths globally
http://www.childinfo.org/mortality_underfive.php
Neonatal Mortality Rate (NMR) - India
Current: 29/1000 live births
Under-five mortality
Infant deaths
Rest
25%
40/1000
live births
Rest
44%
Neonatal
mortality
75%
52/1000
live births
Neonatal
mortality
56%
Accounts for almost ¾ th of IMR & >½ of U5-MR
Source : SRS
Why reduce Malnutrition ?
 According to WHO estimates malnutrition is responsible for around
60% of child mortality
 Malnutrition among children occurs almost entirely during the first
two years of life and is virtually irreversible after that
 As more than 90% of brain develops during first two years child
undernutrition implies cognitive development, intelligence, energy
& productivity loss is tremendous even amongst the survivors
 The global strategy on IYCF recognizes that malnutrition is related
to inappropriate infant feeding practices
Brain development
10 lakh children
die during
first month,
14 lakhs by
1 year, and 20 lakhs
by 5 yrs. 2/3rd are related to poor feeding.
Underweight (-2sd) NFHS-3
Over 60 million
Optimal Infant and Young Child Feeding
 Initiation of breastfeeding immediately after birth, preferably within
one hour
 Exclusive breastfeeding for 1st six months i.e., the infants receives
only breast milk & nothing else, no other milk, food, drink or water
 Appropriate and adequate complementary feeding after six months of
age while continuing breastfeeding
 Full Immunization for infants
 Adequate nutrition for pregnant and lactating women
Trends of IYCF indicators in AP
74.5
80
70
63.7
62.7
62.3
54.9
60
50
40
30
22.4
20
10
0
Initiation of
Exclusive breastfeeding Complementary feeding
Breatfeeding with in 1
(0- 5 months)
(6-9 months)
hour of birth
NFHS(2005-06)
DLHS (2012-13)
Malnutrition among Women in A.P

Anaemia: The percentage of anaemic pregnant women has increased from 41.8% to
56.4% from 1998- 99 to 2005-06
NFHS-2
59.5
56.4
48.6
NFHS-3
57.9
57.1 53.3
49.7
41.8
35.2
20.3
Andhra Pradesh

Karnataka
Tamilnadu
Kerala
India
BMI : Between 1998-99 and 2005-06, there is a marginal decline from 37.4 % to 30.8 %
of women who are having BMI below 18.5
Malnutrition among Children in A.P
 Low Birth Weight Children
-
% of children born with low birth weight
in A.P. is 19.4% which is highest among
the southern states
every 5th child born has birth weight
less than 2.5 kg
-
19.4
18.7
21.5
17.2
Andhra Karnataka Tamilnadu
Pradesh
 Underweight Children
-
% of children below 3 years in A.P who
are underweight is very high at 29.8%
trends shows a slow decline in
reduction of prevalence of under- weight
every 3rd child below 3 years is
underweight
16.1
Kerala
India
Interventions to improve IYCF Practices in AP
– Special weaning food for children 7
months to 3 years and hot meal for
children 3 to 6 years
1
Meaningful Food
Models in ICDS
– Supervised feeding for malnourished
children
– One full meal for pregnant and
lactating women
– Capacity building on skilled IYCF
counselling through counselling courses
2
Intensified Health &
Nutrition Education
– Two Nutrition and Health Days (NHD), one
for growth monitoring and other for health
services
– A convergence initiative of allied depts.
with community
Revised Food Models for Children
“Balamrutham” for 7 months to 3 years
– The new weaning food consists of wheat, channa dal,
sugar, oil & milk powder
– “Balamrutham” is fortified & is a caloric dense food
– is distributed in packets of 2.5 kg per child per
month
– is widely accepted by the mothers
“Hot meal” for Pre-School children
– Hot meal consisting of rice, dal and vegetable
served in the afternoon
– 4 eggs in a week served in the morning and
snacks served in the evening
Balamrutham: Weaning Food for Children < 3 Years
Composition per 100 g
Ingredients
Parts(g)
Energy(kcal)
Protein(g)
Roasted Wheat
Bengal Gram
Skimmed Milk Powder
Sugar
Oil
TOTAL
55
5
10
20
10
100
190.3
18.0
35.7
80
90
414.0
6.4
1.0
3.6
0
0
11.0
Nutritive value per 100 gm
S.No.
GOI Norms
Available Nutrients
1
2
3
4
5
6
7
8
9
10
Energy (kcal)
Protein (g)
Calcium (mg)
Iron (mg)
Vitamin A (µg)
Vitamin B1 (µg)
Vitamin B2 (mg)
Vitamin C (mg)
Folic Acid (µg)
Niacin (mg)
414
11
167
3.1
2.5
0.3
0.2
0.5
7.1
2.3
Fortification
0
0
200
6
200
0.3
0.35
15
15
4
Total
414
11
367
9.1
202.5
0.6
0.55
15.5
22.1
6.3
Supervised feeding for Malnourished Children upto 5 Years
 Identification of malnourished children upto 5 yrs
– children upto 5 years are categorized as
Severely Underweight (SUW) based on
“Weight for age” criteria
– children are also categorized as Severe Acute Malnutrition (SAM)/
Moderately Acute Malnutrition (MAM) based on
“Weight for height” criteria
– children are weighed once in a month & height
measured once in 3 months
 Medical check-up of malnourished children
Supervised feeding-Model Menu for SUW/ SAM/ MAM Children of 7mths – 3 yrs
Sl. Feeding
No. Time
Item
Venue
Quantity
for feeding per day
1
2
3
4
7:30 am
9:30 am
11:30 am
12:15-1:00
pm
Balamrutham
Egg
Milk
Mini Meal +
Extra Oil (5g)*
Home
AWC
AWC
AWC
50g
50g
100 ml
65g
5
3:30 pm
Home
50g
6
7
5:30 pm
7:30 pm
Mashed
Veg./Fruit
Balamrutham
Meal at home +
Extra Oil /Ghee
(5g)
Home
Home
50g
65g
8
Demand
feeding
Breast Milk
Transport
Fuel
Total
Nutritive Value
Tentative cost
Energy Protein Calcium
(Rs.per day)
(Kcal)
(g)
(mg)
2.29
3.50
3.20
1.66
207.00
86.50
117.00
236.12
5.50
6.65
4.30
4.81
183.50
30.00
210.00
13.40
by family
52.50
1.80
16.06
2.29
by family
207.00
236.12
5.50
4.81
183.50
13.40
402.00
6.60
168.00
600ml
0.10
0.20
13.24
1544.24 39.97
817.86
Supervised feeding - Model Menu for SUW/ SAM/ MAM Children of 3 – 6
yrs
Nutritive Value
Sl
No
Feeding
Time
1
7:30 am
2
3
4
5
6
9:30 am
11:30 am
12:151:00 pm
3:00 pm
4:00 pm
7
5:30 pm
8
7:30 pm
Venue for
feeding
Quantity
per day
Tiffin + Extra
Oil/Ghee (5g)
Egg
Milk
Meal +
Extra oil (5g)*
Snack
Balamrutham
(made into
Laddoo /Java)
Fruit + Snack
Home
100 g
AWC
AWC
AWC
Meal +
Extra Oil/Ghee
(5g)
Transport
Fuel
Total
Item
Tentative cost
(Rs. per day)
Energy
(Kcal)
Protein
(g)
Calcium
(mg)
by family
325.00
7.00
20.00
50g
100 ml
125g
3.50
3.20
2.96
86.50
117.00
427.23
6.65
4.30
9.63
30.00
210.00
26.78
AWC
AWC
15-20g
50g
0.83
2.29
80.00
207.00
2.40
5.50
3.40
183.50
Home
50g
by family
200.00
3.00
20.00
Home
125g
by family
427.23
9.63
26.78
0.10
0.20
13.08
1869.96 48.11
520.46
“Spot feeding of One Full Meal” for Pregnant & Lactating women
 Take Home Ration(THR) for Pregnant and Lactating women is
inadequate & consumed by family members
 “Spot feeding of one full meal” been introduced in 101 ICDS projects
out of 254 for 3.35 lakh Pregnant and Lactating women
 “One Full Meal” is likely to
–
–
–
–
improve maternal nutrition
reduce incidence of anaemia
reduce incidence of Low Birth Weight
quickly reduce IMR& MMR
 Funding “One Full Meal”
– Rs 7 per day per women under ICDS
– Additionally Rs 13 per day per women under State budget
What does “One Full Meal” mean ….
Noon Meal:
Rice(125g), Dal(30g),
Veg(50g), Milk(200ml),
Egg(1No.), Oil(16g)
40% of the
RDA
1052 Calories
30.8 g Protein
400 mg Calcium
What does “One Full Meal” mean ….
Counselling
Weight
monitoring
Along with
One full meal
Administration
of IFA
Concurrent Monitoring in Partnership with NGO Alliance, CESS & UNICEF
• Improvement in the Postnatal care
100
90
90
79
80
67
70
60
48
50
40
30
20
19
10
10
0
Low birth weight
Full Immunization
Early iniation of
breastfeeding
Capacity Building on IYCF practices
• Capacity building on skilled IYCF counselling
through counselling courses been taken up by
WCD
• Nearly 400 plus people (AWTC Instructors,
CDPOs, Supervisors) have been trained as
middle level trainers in IYCF using BPNI material
at Hindupur
• Using these Middle Level Trainers the frontline
workers have been trained
Nutrition and Health Days (NHDs) – Growth Monitoring & Counselling
 Instead of one NHD in a month, two NHDs are being conducted
 The focus of NHD-1 is on Growth Monitoring & THR
‒ NHD-1 is conducted on 1st of every month
‒ It allows focus on growth monitoring and categorization of children
as SUW/SAM/MAM
‒ It ensures availability of food stock before 1st of every month
 The focus of NHD-2 is on providing immunization and ANC
services by ANM
 Counselling of mothers is conducted on both NHDs
Convergence – Reducing IMR, MMR, Malnutrition & improving IYCF practices
Maarpu - A
Convergence
Convergence
Initiative A Key
Community
Convergence Structure Institutionalized
Gram
Panchayat
1
2
PHC Level
3
District Level
– Sarpanch as President
– Other members of JB Committee (i.e. MPTC,SHG (2),
Social Activists (2)
– ASHAs, ANMs, VO chairpersons
– GP Secretary as convener & AWW as co-convener
– MPP as President
– Other members of JB Committee (i.e. ZPTC, MPTC(2),
Sarpanches (2), Social Activists (2) , SHG member (1),
MPDO)
– Dy. DM & HO, ICDS Supervisors, MPHS (M&F), MPHEOs,
AWW (RWS),AEE (PR), APM,MMS chairperson
– MO(PHC) as convener & CDPO as co-convener
– District Minister as chairperson, District Collector
– ZP Chairperson, MLAs, CEO (ZP), PD(DRDA),
PD(DWMA), PD(MEPMA),SE(RWS), SE(PR),PO(ITDA),
Addl. DM&HO (MCH& Tribal) DPHN,ZMS chairperson
– DM&HO as member convener & PD (ICDS) as coconvener
Focus on 20 identified key interventions
 Early registration of pregnancy
 Growth Monitoring
 Antenatal check ups
 Complementary feeding
 Maternal nutrition
 Management of illness
 High risk pregnancies
 Referral system
 Birth planning
 Family planning
 Institutional delivery
 Maternal & child death reviews
 Early initiation of breast feeding
 Sanitation & hygiene
 Exclusive breastfeeding for 6 mths  Age at marriage
 Newborn care
 Adolescent girls
 Immunization
 Gender sensitization
• To improve service delivery, to create awareness & to enable behaviour change
• Intensified Health & Nutrition Education by CRPs and health & nutrition
functionaries
Way forward…..
 To prepare annual plans for imparting Nutrition and Health Education
 Need to position additional staff of ICDS mission to strengthen
counselling
 To actively involve community, SHGs and PRIs as partners in these
efforts
 To have close coordination with Health Department for effective
convergence
 To re-design food models in particular for malnourished children &
pregnant women
 To continue the skilled IYCF Counselling training courses
Thank You

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